EFFICACY AND SAFETY OF TERLIPRESSIN INFUSION VS BOLUS TREATMENT IN DIGESTIVE BLEEDING OF VARICEAL ORIGIN AT THE PUEBLA SPECIALTY HOSPITAL, PRELIMINARY RESULTS

Abstract

Introduction and Objectives: Digestive bleeding of variceal origin represents an emergency medical event, with a mortality rate close to 20% and drug treatment is one of the pillars of management. In our environment and according to international recommendations, terlipressin administered in boluses is the treatment of choice for this entity, with a high percentage of adverse effects related to its use, so it is relevant to find other strategies in its use, but without reducing its use effectiveness. Some studies suggest that the use of terlipressin by continuous infusion could represent a more effective or comparable strategy for the control of bleeding, a lower rate of adverse effects and a lower risk of rebleeding, so the objective of this study is to compare the efficacy and safety of terlipressin in intermittent dose vs. infusion for acute bleeding of variceal origin in patients with portal hypertension. Material and methods: this is a randomized, open, comparative and prospective study that included adult patients with a diagnosis of portal hypertension of any origin, with manifest gastrointestinal bleeding, treated at the Puebla Specialty Hospital since March 1, 2021, who were randomly administered terlipressin by infusion and boluses. Study variables: treatment failure, adverse effects, days of hospital stay and transfusion requirement. The protocol was approved by the local committee and conbioethics 21-CEI-002-20180731, all patients participated with informed consent. Results were analyzed with frequency measures, Fisher's exact test was used to demonstrate hypotheses, and Student's t-test was used for unrelated normal distribution variables. Results: Up to now, 10 patients have been admitted to the study, in which no significant differences have been obtained in the study variables; however, in the bolus terlipressin group, three of the five patients have presented adverse effects, unlike the infusion terlipressin group in which they have not been presented. Discussion: At the moment, a total of 10 patients has demonstrated comparable effectiveness in both groups; however, in the bolus group, 60% of the patients have presented adverse effects that have led to the change of vasoactive drug, unlike the infusion group where there have been no adverse effects, however, no significant differences have been found between both groups, which is explained by the small number of patients at the moment. Conclusions: We consider that a larger number of patients is required to demonstrate our hypothesis.The authors declare that there is no conflict of interest.